Business Group Blog

Welcome to our blog.

The Business Group Blog was created to share and discuss information about challenges and solutions to the health care benefits issues that large employers face today and tomorrow — such as controlling health care costs, reforming the health care delivery system, and engaging employees in their health and benefits — and will provide insight into national health policy issues. We hope you find this information useful and will consider subscribing to the blog and sharing any thoughts or ideas with us at blog@businessgrouphealth.org.

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According to a study published this month, physicians estimate that 20.6% of overall medical care is unnecessary. Researchers from Harvard Medical School and Johns Hopkins University School of Medicine interviewed 2,106 doctors from across the United States, asking them about the prevalence and causes of overtreatment.

Accountable care organizations (ACOs) are being considered as one the key strategies in the next frontier of efforts to improve health care delivery and control health benefit costs. Roughly one in four large employers plan to pursue an ACO strategy in 2017 and that number is expected to grow in the coming years. However, employers have many questions about how ACOs deliver value better than the network models they offer today. To help employers better understand and evaluate ACOs in their markets, two groundbreaking tools have been released by the National Business Group on Health.

The Business Group is pleased to roll out a Public Policy Issue Brief that offers public policy recommendations to create a more favorable environment for financial sustainability and affordability of specialty medications. At the outset, understanding the challenge is important. With specialty drug expenditures trending at an all-time high and all indicators pointing to sustained increases over time, employers are strategizing on how best to manage growing pharmacy expenditures for this subset of drugs.

It’s important that a governance structure for benefits be in sync with the overall mission and goals of a company. What is at stake, among other things, is a company's fiscal health. Employers want to secure their employees’ health and well-being consistently across their operations in different local and global markets.

Patient (or “copay”) assistance programs and coupons present a bit of a double-edged sword. While they help facilitate payment for certain drugs, they also complicate the payment process immensely. Both help patients ultimately gain access to expensive drugs that otherwise may not be affordable. However, the intention behind each approach differs considerably, as does the overall impact.

The Department of Health and Human Services (HHS) launched the Health Care Payment and Learning and Action Network (LAN) in 2015 to align stakeholders across sectors in moving payment from traditional fee-for-service (FFS) methods to one linked to quality via alternative payment models (APMs). The LAN is an unprecedented collaboration of stakeholders from the private, public, and non-profit sectors whose goal is to transform the nation’s health system by supporting health care value over volume.

Each January, more than 100 human resources and benefits professionals come together for our annual Employers’ Summit on Health Care Costs and Solutions. The best practices and cutting-edge ideas brought forward at this event continue to show that innovation in health improvement and health care management in this country is driven largely by employers.

Twenty-one percent of large employers plan to actively promote accountable care organizations (ACOs) in 2018 and another 26% are considering doing so in 2019/2020. Close to a quarter of large employers (24%) plan to actively promote accountable care organizations (ACOs) in 2017. ACOs consist of health care providers that are creating a delivery model that ultimately accepts responsibility for the quality and cost of care for a defined population. However, it is not always clear how ACOs differentiate from the market or how they are consistently achieving initial contract goals and reducing costs. A common question employers ask is, “Is an ACO right for my company?”

Are you struggling with managing specialty pharmacy in plan design? Our new Specialty Pharmacy Management Checklist provides detailed tips for staying ahead of the curve – from utilization management to reporting and accountability to employee education.

Controlling health benefits costs remains a high priority for large employers. While increases are expected to hold steady at 6% in 2017, costs are still running at more than twice the rate of inflation and general wage increases, thereby threatening affordability.